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[lblClaimFormReview]|||
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Name: [lblNameDisplay]                  Shipment #: [lblRegDisplay]|||
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Email Address:  [lblEmailDisplay]       Home Phone: [lblHomePhoneDisplay]|||
Work Phone/Ext:	[lblWorkPhoneDisplay]   Wireless or Cell Phone: [lblCellPhoneDisplay]|||
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Current Address: [lblAddrDisplay] [lblCityDisplay]|||
Mailing Address: [lblMailingAddrDisplay] [lblMailingCityDisplay]|||
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Was your shipment stored in a warehouse? [lblShpmtStrdDisplay]|||[lblAgentCityDisplay]|||
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Move To Address:   [lblMoveToAddr]  [lblMoveToCity]|||
Move From Address: [lblMoveFromAddr]  [lblMoveFromCity]|||
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Overall Comments:|||
[lblComments]|||
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